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The analytical results of the association between the Movement and Assistance of Hospital Patients (MAPO) index and acute low back pain in nursing staff are presented. The MAPO index can be used as a risk index to assess the risk exposure level of patient manual handling in wards, and can be a useful tool for planning effective preventive actions to reduce the risk of musculoskeletal disorders in health-care workers handling disabled patients.

A programme for the reintegration into the workplace of workers with work-related musculoskeletal disorders (WMSDs) of the upper limbs will need to take into account whether tasks should be re-designed to accommodate WMSD-affected workers. The main aim of such a programme should be to eliminate the clinical indications and symptoms connected with the WMSD while also maintaining the worker's productivity. Attention must be given to boosting worker awareness of WMSDs.

Musculosketal disorders of the upper limbs (WMSDs) are generally regarded as work-related, but can in fact occur in people not exposed to work-related risk factors. There is little information on this subject, but research undertaken in Italy indicates that WMSDs are very uncommon among workers who do not undertake tasks with repetitive movements of the upper limbs, particularly among younger people. There is no evidence of gender-related differences in WMSD risk factors.

Copyright of La Medicina del Lavoro is the property of Mattioli 1885 SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of La Medicina del Lavoro is the property of Mattioli 1885 SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of La Medicina del Lavoro is the property of Mattioli 1885 SpA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: In the past ten years European and Italian statistics reported a significant increase in work-related musculoskeletal disorders, which also covered the construction industry. Objectives: To verify this issue, the EPM Research Unit, in collaboration with the Small Craft Industries Territorial Joint Committee in Bergamo (CPTA), undertook a research project on muscular-skeletal disorders. Methods: The health survey was carried out by an ad hoc trained staff. Results: Between November 2009 and September 2010, data on 2755 subjects were obtained. The entire sample and the group of masons were investigated and both exhibited high prevalence of upper limb disorders and high prevalence of degenerative diseases (herniated disc). Conclusions: Active research needs to be included in the protocol of health surveillance, of upper limb and spinal MSDs. The data also highlight the need for biomechanical overload exposure data aimed at reconstructing risk profiles and at identifying the technological and organizational solutions to eliminate this particular risk. [ABSTRACT FROM AUTHOR]

This article illustrates the evolution of the MAPO method for quantifying the risk of musculoskeletal disorders associated with patient handling.The main factors that have influenced MAPO risk determinants include the rising number of disabled patients (D), growing understaffing, and the increased availability of equipment and training.Hospital wards and especially nursing homes have been provided with lifting equipment since 2008; however, 73.8% of the workforce in nursing homes is exposed to a high level of MAPO risk versus only 8.1% of hospital workers. This study presents organisational data in hospital wards (no.=528) and nursing homes (no.=214) involving 14,246 caregivers: the D/Op ratio in nursing homes is significantly higher compared to the corresponding ratio in hospital wards ( p -value < 0.001). Moreover, the number of healthcare workers involved in manual patient handling activities over the night shift in nursing homes is much lower than the corresponding number in hospital wards. Practitioner summary: The purpose of this article is to illustrate organisational data from hospital wards and nursing homes, gathered over 20 years of implementing the MAPO method. The protocols for adapting the method to recent changes in care delivery are also presented.

Introduction: Health surveillance programs conducted for both individual workers and working populations as a whole are managed by occupational health physicians and focus on disorders and diseases caused by biomechanical overload, primarily for preventive purposes., Objectives: The purpose of the paper is to update an anamnestic protocol for studying musculoskeletal disorders after more than 40 years experience of its application. The updated version has been re-named the Latin Questionnaire. The protocol enables preliminary epidemiological evaluation, by comparing results of exposed populations to those from a reference population, thanks to the introduction of a severity threshold, a concept lacking in similar questionnaires., Methods: The Latin Questionnaire is based on symptoms of discomfort, pain, and paraesthesia. Each symptom is described in terms of location, duration, number of episodes, irradiation, and treatment. The model covers present symptoms during the previous 12 months and is designed to identify positive anamnestic cases (when positive according to the threshold), cases with minor disorders, and negative cases for conditions involving the spine and upper and lower limbs., Results: The updated anamnestic model was validated again through the collaborative effort involving 37 physicians from 14 Latin countries. To enable comparisons with exposed populations, an updated reference population (4,000 unexposed workers) is presented, evaluating the percentages of subjects positive according to thresholds for spine and upper and lower limbs and the incidence of acute lower back pain, broken down by gender and age groups. Examples of application of the questionnaire are also presented., Conclusions: The Latin Questionnaire, which has also been implemented in digital form (free download), allows selection of significant anamnestic cases compared to cases with minor disorders. This strategy is indispensable for correctly conducting preliminary epidemiological studies. Example applications confirm the presence of significant differences between the percentages of subjects with positive thresholds in exposed compared to reference groups, with surpluses proportional to their levels of biomechanical overload., Competing Interests: Conflicts of interest: None

Objective: To validate the effectiveness of MAPO method (Movement and Assistance of Hospital Patient) after the introduction of some changes to improve assessment objectivity., Background: The number of operators exposed to patient manual handling is increasing considerably. MAPO, proposed in 1999 as a useful tool to estimate the risk of patient manual handling, is a method characterized by analytical quickness. It has recently been improved to better match the 2012 ISO (International Organization for Standardization) technical report., Methods: A multicenter study was conducted between 2014 and 2016 involving 26 Italian hospitals in the Apulia Region. MAPO method was used to assess the risk of patient manual handling in 116 wards. A total of 1,998 exposed subjects were evaluated for the presence or absence of acute low back pain in the previous 12 months., Results: Only 12% of the investigated wards fell in the green exposure level (MAPO index = 0.1-1.5), 37% resulted in the average exposure level (MAPO index = 1.51-5) and the remaining 51% in the higher exposure level (MAPO index >5). The results confirmed a positive association between increasing levels of MAPO index and the number of episodes of acute low back pain (adjusted p trend = .001)., Conclusion: The improvements made over the past years led to a more objective assessment procedure. Despite the changes, the study confirmed the effectiveness of MAPO method to predict low back pain., Application: MAPO method is an accurate risk assessment tool that identifies and evaluates workplace risks. The proper application of the method significantly improves working conditions.

Background: Data on the prevalence of work-related musculoskeletal disorders (WMSDs) in groups of unexposed subjects may serve for comparison in studies on risk/damage in groups of exposed subjects and for the planning of preventive interventions., Objectives: To assess the musculoskeletal health status in a group of working subjects not exposed to biomechanical overload., Methods: Medical histories were collected by occupational health physicians as part of an active health surveillance program. An ad hoc questionnaire was administered to the subjects to detect musculoskeletal disorders., Results: The sample consisted of 1023 subjects (605 females and 418 males) with a mean age of 40 years. The prevalence of acute low back pain and disc hernia was 4% and 5.6% respectively; 4.3% of subjects were affected by at least one disorder of the upper limbs while the prevalence of knee disorders was 1.7%. Standardized data proved to be in line with previous studies with the exception of a greater prevalence of shoulder disorders and disc hernia., Conclusions: WMSDs occur ubiquitously across the general working population unexposed to biomechanical overload. Such findings represent a valid reference for groups of exposed working subjects, in that any excess of such disorders/pathology may be due to specific work conditions.

Objective The aim of this study was to explore whether the Variable Lifting Index (VLI) can be corrected for cumulative mass and thus test its efficacy in predicting the risk of low-back pain (LBP). Background A validation study of the VLI method was published in this journal reporting promising results. Although several studies highlighted a positive correlation between cumulative load and LBP, cumulative mass has never been considered in any of the studies investigating the relationship between manual material handling and LBP. Method Both VLI and cumulative mass were calculated for 2,374 exposed subjects using a systematic approach. Due to high variability of cumulative mass values, a stratification within VLI categories was employed. Dummy variables (1-4) were assigned to each class and used as a multiplier factor for the VLI, resulting in a new index (VLI&#95;CMM). Data on LBP were collected by occupational physicians at the study sites. Logistic regression was used to estimate the risk of acute LBP within levels of risk exposure when compared with a control group formed by 1,028 unexposed subjects. Results Data showed greatly variable values of cumulative mass across all VLI classes. The potential effect of cumulative mass on damage emerged as not significant ( p value = .6526). Conclusion When comparing VLI&#95;CMM with raw VLI, the former failed to prove itself as a better predictor of LBP risk. Application To recognize cumulative mass as a modifier, especially for lumbar degenerative spine diseases, authors of future studies should investigate potential association between the VLI and other damage variables.

Objective: The aim of this study was to evaluate the efficacy of the new Variable Lifting Index (VLI) method, theoretically based on the Revised National Institute for Occupational Safety and Health [NIOSH] Lifting Equation (RNLE), in predicting the risk of acute low-back pain (LBP) in the past 12 months., Background: A new risk variable termed the VLI for assessing variable manual lifting has been developed, but there has been no epidemiological study that evaluates the relationship between the VLI and LBP., Method: A sample of 3,402 study participants from 16 companies in different industrial sectors was analyzed. Of the participants, 2,374 were in the risk exposure group involving manual materials handling (MMH), and 1,028 were in the control group without MMH. The VLI was calculated for each participant in the exposure group using a systematic approach. LBP information was collected by occupational physicians at the study sites. The risk of acute LBP was estimated by calculating the odds ratio (OR) between levels of the risk exposure and the control group using a logistic regression analysis. Both crude and adjusted ORs for body mass index, gender, and age were analyzed., Results: Both crude and adjusted ORs showed a dose-response relationship. As the levels of VLI increased, the risk of LBP increased. This risk relationship existed when VLI was greater than 1., Conclusion: The VLI method can be used to assess the risk of acute LBP, although further studies are needed to confirm the outcome and to define better VLI categories., (© 2016, Human Factors and Ergonomics Society.)

Background: Cashiers are not the only workers in the Retail Sector (RS) who are exposed to biomechanical overload risk of the upper limbs and spine., Objectives: To investigate the prevalence of musculoskeletal disorders among employees in the RS., Methods: 3380 Italian workers were asked to complete a standardized medical history questionnaire to collect data on symptoms and diagnosed disorders affecting upper limbs, spine and knees. These were then compared with data on subjects not exposed to biomechanical overload risk., Results: 21.1% of the workers reported at least one disorder affecting the upper limbs (OR 5.05), i.e., shoulder (OR 3.39), elbow (OR 4.25), wrist/hand (OR 8.39) and CTS (OR 8.70). The prevalence of disc hernia was 16% (OR 3.82). A high prevalence of knee complaints was also found among subjects employed in the RS (OR 1.73)., Conclusions: The high prevalence of musculoskeletal disorders seems to confirm the presence of a risk of biomechanical overload for most job positions in the retail sector, although a possible selection bias cannot be completely ignored. Recommendations for future studies aiming to confirm our results include: involving all workers in every store and collecting information about diagnostic procedures.

Large scale retail industry and catering industry are characterized by the widespread presence of several risk factors of work-related musculoskeletal disorders (WMSD): repetitive movements, incongruous postures and manual handling tasks. We reviewed current epidemiological evidence related to musculoskeletal disorders within these two sectors, distinguishing between symptoms and clinically documented disorders. In retail industry cashier is the most investigated figure, regarding upper limbs disorders as a consequence of repetitive tasks. In the catering sector there are few studies, mostly focused only on the job as a cook. The majority of studies showed a high prevalence of WMSD and, to a lesser extent, a high frequency ofmusculoskeletal alterations; suggesting the presence of a not negligible risk. These findings, however, are affected by a number of methodological limitations: they derive from cross-sectional studies, are based on voluntary self-selected workers, are focused on not unequivocally defined health outcomes, and are usually lacking a proper comparison. with the prevalence in less exposed/reference working groups. In order to achieve an effective control of the workers' risk, it is therefore necessary to design and conduct prospective studies that compare the risk of developing disorders and/or diseases in workers exposed to different levels of biomechanical load. It appears essential to involve occupational physicians in active health surveillance programs in order to identify critical areas and to develop effective preventive measures.

Background: The survival of manufacturing in the western world also depends on the ability to increase productivity. To achieve this goal, it is necessary to recover the efficiency of all workers suffering from upper limb biomechanical overload disease. Ergonomic methods can be a valuable tool in solving this apparent conflict: operatives'productivity and health., Methods: After carrying out an ergonomic education and training programme for all company employees and risk assessment for upper limb biomechanical overload through the OCRA checklist method, a programme of improvements on a production line was planned and tested, mainly based on international and European standards., Results: Within approximately 2 years, thanks to changes in workplace layout and organization, a significant reduction of 22.7% in risk level was achieved and, at the same time, a 16% increase in productivity., Discussion: An ergonomic approach based on global, interdisciplinary and participatory principles in the case considered showed that it is possible to match increased productivity with decreased risk. In this specific case application of ergonomic principles during product design was rather poor, which is typical of companies working for third party customers.

Background: The Basilicata Regional Headquarters of the Italian Institute for Insurance against Occupational Accidents and Disease (INAIL) and the Basilicata association of small building enterprises (Edilcassa di Basilicata) promoted a research project to assess the risk of manual lifting and manual transport in construction enterprises in the Basilicata Region and estimate the prevalence of related diseases., Methods: Manual lifting risk assessment was performed by calculating the VLI of 204 working days in as many building workers. Manual transport risk assessment was carried out comparing the weights transported (on the 204 days tested) with the reference values of the "Snoock and Ciriello" tables., Results: Manual Ifting risk was present on 195 of the 204 days, with an average value of VLI equal to 2.1 (min 0.4, max 8.5), with higher values in the restructuring sector (VLI average of 2.3, min 0.4, max 8.5), and no significant differences between the different tasks. Manual transport risk was present on 129 of the 204 days, with average values of 1.2 (min 0.2, max 3.3), with no significant differences between the different tasks analyzed For both risks additional factors were present that were not analyzed by the methods of assessment used (for manual lifting: 8.8% of the geometries in the critical area; for manual transport: 39% of transport on shoulders, 42.5% on a route with uneven surface and 31.9% on a sloping route), so it is likely that the actual risk is greater than that indicated by the synthetic indices of exposure. The medical questionnaire showed from the case histories that 148 out of 546 subjects were positive for the threshold forpain or discomfort in the lumbosacral spine area and 99 out of 546 subjects reported suffering from an already diagnosed herniated spinal disk. Only 18% of osteoarticular diseases was reported to the Insurance Institute, al though there was widespread awareness that the diseases in question might be related to work. Diseases of the spine were responsible for 1.9% of absenteeism, equal to 30-40% of total absenteeism ofworkers enrolled in "Edilcassa di Basilicata"., Conclusions: The method used provides a solid basis for evaluating the two risks in the construction industry, where employment is subject to extreme organizational, environmental and structural (machines, tools, operators involved) variability. Employment in the construction industry involves significant exposure to the two risks, counting for 30-40% of total absenteeism in this sector.

Background: In the past ten years European and Italian statistics reported a significant increase in work-related musculoskeletal disorders, which also covered the construction industry., Objectives: To verify this issue, the EPM Research Unit, in collaboration with the Small Craft Industries Territorial Joint Committee in Bergamo (CPTA), undertook a research project on muscular-skeletal disorders., Methods: The health survey was carried out by an ad hoc trained staff., Results: Between November 2009 and September 2010, data on 2755 subjects were obtained. The entire sample and the group of masons were investigated and both exhibited high prevalence of upper limb disorders and high prevalence of degenerative diseases (herniated disc)., Conclusions: Active research needs to be included in the protocol of health surveillance, of upper limb and spinal MSDs. The data also highlight the need for biomechanical overload exposure data aimed at reconstructing risk profiles and at identifying the technological and organizational solutions to eliminate this particular risk.

Background: International standards draw attention to the steps that risk assessment should follow to first identify hazards, then proceed to risk evaluation and lastly, if necessary, risk assessment. The same logic also applies to risk assessment of manual patient handling., Objectives: To check appropriateness of approach to "risk evaluation" of manual patient handling using MAPO, a cross sectional study was carried out aimed at checking the relationship between this new risk assessment model (MAPO screening) and occurrence of acute low back pain., Methods: After proper training the MAPO screening method was used to assess risk of manual handling of patients in 31 wards, covering 411 exposed subjects employed in geriatric hospitals belonging to the UNEBA (National Union Institutions and Social Welfare Initiatives) of the Veneto Region. At the same time health data were collected on the occurrence of low back pain episodes during the last year both in the group of exposed subjects and in an external reference group (237 subjects). Risk and clinical assessment data were verified and checked by the EPM research unit. Logistic analysis was used as a method to evaluate the relationship between MAPO screening risk index and acute low back pain., Results: Investigating the relationship between acute low back pain episodes and levels of MAPO screening index, carried out only on exposed subjects who reported working for at least 30 hours per week (N=178), showed definitely positive trends: for MAPO screening index of exposure levels between 1.51 and 5, OR were double (OR=2.22; IC 95% 0.88-5.63) whereas for index levels exceeding 5, OR were about 4 (OR=3.77; IC 95% 1.33-10.74). These results did not show significant differences when correcting the analysis for confounding factors such as gender and age classes., Conclusions: The results of the study indicate that the proposed method, "MAPO screening", can be a useful tool to estimate risk due to manual handling of patients and can also be used to test the efficacy of preventive measures.

International standards highlight the steps required by risk assessment and involving first hazard identification, then risk evaluation and finally, if necessary, risk assessment. To check approach appropriateness to "risk evaluation" from manual patient handling through MAPO, a cross study was carried out in view of checking relationship between this new risk assessment model and occurrence of acute low back pain. After proper training the MAPO screening method was assessed in 31 wards, 411 exposed subjects of geriatric hospitals. At the same time health data were collected on occurrence of low back pain episodes during the last year both in the exposed subjects' group and the external reference group (n�237). Risk and clinical assessment data were tutored and checked by EPM research unit. The logistic analysis was used as a method to evaluate the relationship between risk index and acute low back pain. Investigating relationship between acute low back pain episodes and levels of MAPO screening index, carried out only with the people exposed who claimed to work for at least 30 hours per week (n = 178), showed definitely positive trends. The study results indicate that MAPO screening may represent a useful tool to estimate the risk from manual handling patients.

Background: In the past ten years European and Italian statistics reported a significant increase in work-related musculoskeletal disorders, which also covered the construction industry., Objectives: To verify this issue, the EPM Research Unit, in collaboration with the Small Craft Industries Territorial Joint Committee in Bergamo (CPTA), undertook a research project on muscular-skeletal disorders with special reference to the lumbar spine and upper limbs., Methods: The health survey was carried out by an ad hoc trained staff, Results: Between November 2009 and July 2010, data on 2247 subjects doing a variety of jobs were obtained, more than 50% of whom were masons. The entire sample and the group of masons were investigated and both exhibited a prevalence of upper limb disorders that was definitely higher than in the reference group of non-exposed subjects. Regarding the lumbar spine, the most significant evidence was the high prevalence of degenerative diseases (herniated disc), while subjective disorders appeared to be lower than in the reference groups. These data are influenced by the healthy worker effect, which is extremely marked in this industrial sector, as well as by the economic crisis that led to many workers having to leave., Conclusions: Active research needs to be included in the protocol of health surveillance (with appropriate clinical protocol), of upper limb and spinal MSDs. The data also highlight the need for biomechanical overload exposure data aimed at reconstructing risk profiles (from biomechanical overload)for each job and at simplifying risk assessment requirements according to present legislation but above all at identifying the technological and organizational solutions to eliminate this particular risk.

Background: The literature dealing with the health effects of VDU work identified right from the beginning a group of MSDs, mainly affecting the cervicobrachial region, so that VDU work could be considered a risk factor due to biomechanical overload of the upper limbs,, Objectives: The aim of the study was to assess the prevalence of symptoms and diseases of VDU workers., Methods: A cohort of 2022 workers (1125 males and 897 females) working at VDUs for a duration of time equal to or exceeding 20 hours per week, including insurance and bank employees (no desk activity), was submitted to clinical and functional assessment of the cervical spine and upper limbs following a structured protocol (case history, clinical and instrumental examinations), as used by occupational physicians, in order to identify "anamnestic cases" and diagnose upper limb biomechanical overload diseases. Besides medical data, a series of data was also collected in order to obtain details of the work task: time schedule, duration of VDU use, organizational autonomy, data entry method., Results: The prevalence of subjects with UL-WMSDs was 1.9% for males and 5.8% for females, and basically similar to that found in non-exposed working populations. However, there did seem to be a correlation between cervical disorders and computer use, only for females., Conclusions: In the sample studied no association was shown between VDU work and onset of upper limb diseases, which was confirmed even considering the different exposure variables. Analysis of"anamnestic cases" made by comparison with non-exposed populations, confirmed the lack of association between upper limb diseases and VDU work.

Background: For several years the literature has reported a high prevalence of upper limb musculoskeletal disorders among medical staff carrying out digestive endoscopy., Objectives: The EPM research unit, in cooperation with the Italian Society of Digestive Endoscopy (SIED) and with the patronage of the Italian Society of Ergonomics (SIE), undertook research that would permit assessment of upper limb biomechanical overload using the OCRA method during gastroscopy and colonoscopy and, via a pilot study, collect health data on 179 workers employed in endoscopy services., Results: Risk analysis showed slight exposure levels for the arm bearing the instrument and a medium-to-high exposure for the other arm. However, the study of diseases in this sample showed a higher prevalence than in the reference population not exposed to risk for the upper limbs and in particular in the hand-wrist area., Conclusions: Risk analysis highlighted possible ergonomic measures that would be easy to implement and which would significantly reduce the risk.

Background: Trends in work-related upper limb musculoskeletal disorders appear to be in constant increase in industrialized countries. In Europe claims and compensation for these disorders have significantly increased., Objective: The aim of this study was to investigate the temporal relationship between the beginning of occupational exposure to repetitive movements and exertions of upper limbs, assessed through the OCRA index, and the manifestation of the disorders., Methods: Clinical and questionnaire information about 557 cases of UL-WMSDs in the upholstered furniture industry were analyzed in order to investigate the mean latency period of the disorders and to verify to what extent different levels of exposure influence the latency time., Results and Conclusions: The latency of UL-WMSDs is influenced by the level of exposure to risk, measured by means of the OCRA index. Shorter latency times were found for wrist/hand tendonitis, with a mean latency time of 5.4 years and with a greater sensitivity to the level of exposure assessed with the OCRA index value. This might support a sort of predictive value with reference to other UL-WMSDs with longer latency. Probably a latency period of 12 years may be suggested as the cut-off limit to assess a causal relationship between tendon or canalicular WMISDs and occupational exposure to repetitive movements and exertions of upper limbs.

Background: The epidemiological evidence of work-related musculoskeletal disorders (UL-WMSDs) due to repetitive strain and movements in the various industries has been collected in the literature mainly through cross-sectional surveys. In particular there are no contributions so far regarding the upholstered furniture industry with a longitudinal design., Objectives: The aim of the study was to evaluate the incidence rate of WMSDs such as hand-wrist and shoulder tendonitis, carpal tunnel syndrome, and epicondylitis in exposed workers of three large companies of the upholstered furniture industry in a large geographic area of southern Italy., Methods: The OCRA method, recommended by international standard ISO 11228-3 and EN 1005-5, was used for risk assessment. The following work tasks were considered:.filling preparation workers, leather-cutting operators, sewing and upholstery-assembly workers. A total population of 5,278 subjects (exposed n=2927, controls n=2351) was investigated. The person/year at risk parameters were calculated from 1 January 2000, or from the date of engagement if later, until the first diagnosis of WMSD or, in absence of disorders, until the end of the study, i.e. 31 December 2004. Disorders occurring after the first were not considered. A multiple regression analysis was used to evaluate relationships between rates., Results and Conclusions: Incidence rates correlated with risk classes of the OCRA index. An incidence rate of WMSDs higher than 1.2 cases per 100 person/year may be considered as a threshold value to suspect an occupational exposure to repetitive strain and movements warranting further investigation. The analysis of single factors did not show a greater predisposition of the female gender, with the single exception of the carpal tunnel syndrome (RR 2.92; 95% CI 1.57-5.43). Shoulder disorders affected mainly male leather-cutting operators (RR 4.97; 95% CI 2.03-12.16) and among all the factors influencing risk (frequency, force, posture, additional risk factors, pauses) posture seems to play a significant role.

Background and Objective: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law., Contents: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

A total of 306 employees of the hospitals of the Leno/Manerbio health area underwent clinical and anamnestic examination in order to ascertain the existence of degenerative diseases of the spine associated with "manual handling of loads" risk. The prevalences obtained for positive anamnestic threshold concerning the lumbosacral spine, the trend of total acute low back pain and of low back pain in the last year showed lower values compared to the entire national group and in any case lower or only slightly above the values for the reference group of non-exposed subjects. Therefore, in order to assess the real prevalences of disorders due to incorrect load handling in hospital environments, it is important to assess the presence of associated disorders of the spine also and especially in outpatients departments. In fact, unsuitable or unfit staff had recently been transferred from the wards to outpatients departments. 56 workers from outpatients departments underwent physical-anamnestic examination: 16 workers (4.5% of the entire group under study) from average-to-high risk wards were identified as suffering from degenerative disorders of the lumbosacral spine. Therefore the prevalence of unfit subjects from hospital wards, cancelling the effect of the turnover factor on outpatients departments, led to an almost twofold total frequency, which rose from 6.9% to 11.4%.

The paper reports the results of risk evaluation of patient lifting or moving obtained from a multicentre study on 216 wards, for both acute hospital patients and in geriatric residences. In all situations the exposure to patient lifting was assessed using a concise index (MAPO). Analysis of the results showed that only 9% of the workers could be considered as exposed to negligible risk (MAPO Index = 0-1.5); of these 95.7% worked in hospital wards and only 4.3% in geriatric wards. A further confirmation of the higher level of exposure of workers in long-term hospitalization was that 42.3% were exposed to elevated levels (MAPO Index > 5) compared with 27.7% observed in hospital ward workers. The mean values of the exposure index were 6.8 for hospital wards and 9.64 for geriatric residences and, although much higher in the latter, both categories showed high exposure. In the orthopaedic departments of the hospitals the values were higher than in the geriatric wards (MAPO Index = 10.1); medical and surgical departments showed values similar to the mean values observed in the geriatric wards. These high values were due to: severe shortage of equipment life lifting devices (95.5%) and minor aids (99.5%), partial inadequacy of the working environment (69.2%), poor training and information (96.1% lacking); only the supply of wheelchairs was adequate (65.8%). All of which points to an almost generalized non-observance of the regulations listed under Chapter V of Law No. 626/94. However, the proposed method of evaluation allows anyone who has to carry out prevention and improvement measures to identify priority criteria specifically aimed at the individual factors taken into consideration. By simulating an intervention for improvement aimed at equipment and training, 96% of the wards would be included in the negligible exposure class (MAPO Index 0-1.5).

The aim of the study was to measure the occurrence (prevalence and incidence) of episodes of acute low back pain (definite effect) in a wide sample of health workers assisting disabled patients. A questionnaire was used for the study both of true acute low back pain and of episodes of ingravescent low back pain controlled pharmacologically at the onset. The questionnaire identified overall acute and pharmacologically controlled episodes occurring in the previous 12 months, both in the course of work and over the whole life of the subject. Appropriately trained operators administered the questionnaire to 551 subjects; 481 valid answer cards were obtained from 372 females and 109 males working in medical, orthopaedic and geriatric departments. 75.4% of the sample had high exposure index levels for patient lifting. The prevalence of true acute low back pain was 9% in males and 11% in females referred to the previous 12 months. Taking acute true and pharmacologically controlled low back pain together the prevalences rose to 13.8% for males and 26.9% in females. Data from the reference populations showed that acute low back pain did not exceed 3% on average in the previous year. Since work seniority in the hospital wards was known, the incidences were calculated, giving 7.9% in females and 5.29% in males for acute low back pain, and 19% in females and 3.49% in males for pharmacologically controlled low back pain. Considering the number of episodes in 100 workers/year, acute low back pain alone reached prevalences of 13-14%. This therefore appears to confirm the positive ratio between episodes of low back pain and duties involving assistance to disabled patients.

Current Italian legislation establishes all necessary details of intervention procedures aimed at elimination or substantial reduction of risk due to manual lifting of patients. Chapter V of Law No 626/94, which was a thoroughly innovative step in the field of safety, hygiene and prevention at the workplace, in 3 articles and one annex incorporated Community Directive 269/90 into Italian legislation. The model to approach manual load handling, whose definition can in all respects be transferred to health facilities where load means patients who are not self-sufficient in movement, sets out a precise strategy of actions. The first action is automation of the "production process", which is inapplicable in the health care sector; the second action is to provide "aids", which is perfectly applicable to the health care sector. A further action foreseen by the regulations that should be taken into consideration in addressing the problem of manual patient handling from the point of view of prevention is found in the Law (Presidential Decree) of 14/1/97 concerning criteria of accreditation of health facilities, which also refers to the regulations contained in Law 626/94. As regards the insurance coverage of acute or chronic impairment due to manual handling of loads/patients, these aspects are still not contemplated in any regulations. This contradiction became even more evident with the introduction of Law No 626/94 where in Chapter V reference is made to "dorsal-lumbar lesions". Although these lesions are recognized legally in the acute form (accidents), there are also degenerative diseases with chronic development, and the latter are not given any protection apart from the theoretical recognition contained in the Constitutional Court Sentence 179/88. It is to be hoped that the review process of the list of compensable occupational diseases will address this problem, too, so that it can be solved as soon as possible.

Via a multicentre study coordinated by the EPM research group carried out in 216 wards in a total of 56 hospitals, old peoples homes and geriatric departments, it was possible to quantify exposure to patient handling (classified in 4 classes: 0-1.5 negligible, 1.51-5 slight to average, 5.01-10 average to high, > 10 elevated), and at the same time identify the damage to the lumbosacral spine thus caused. Both assessment of exposure and identification of health impairment were carried out using homogeneous methods. Subjects with work seniority in the job of less than 6 months and subjects who had been transferred because of back trouble were excluded from the study. It was therefore possible to carry out two types of study to assess the association between exposure and impairment. In study A, covering 3021 subjects, an analysis was performed of the association between exposure index, positive response to the anamnestic threshold for lumbosacral disorders and acute low back pain using the method of logistic analysis to obtain the prevalence odds ratios. In study B, covering 418 subjects, the analysis of association was performed on the incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain, assuming that exposure in the wards had remained constant. The technique used was Poisson regression, thereby calculating the relative incidence rate ratios. Both for PORs and IRRs the reference group consisted of the exposure class judged as negligible (exposure index 0-1.5). The results showed that the PORs calculated for positive lumbar threshold were significant for increasing exposure classes with a positive trend for the second and third exposure class but not for the last, presumably due to a healthy worker selection effect. Neither in Study A nor in Study B were any associations observed between exposure and acute low back pain occurring in the previous 12 months: this may be due to the fact that the impairment indicator does not appear to be appropriate in terms of latency period. A different result was obtained in Study B which showed a good association between exposure and incidence rates of episodes of acute low back pain and pharmacologically controlled acute low back pain according to department. The IRRs showed a positive trend both for acute episodes (IRR: 1.932, 2.439, 2.847) and for acute plus pharmacologically controlled acute episodes (1.798, 1.830, 4.523). On the basis of these results, even with the caution required for the reasons explained in the text, it seems to be possible to identify three grades of exposure which correspond to increasing probability of impairment of the lumbosacral region of the spine: the first where risk seems negligible corresponds to an exposure level between 0 and 1.5. The second, where the episodes of low back pain may occur with an incidence 3.8 times greater, corresponds to an exposure level between 1.51 and 5, and the third corresponds to exposure levels exceeding 5, where the episodes of low back pain may occur with an incidence up to 5.6 times greater than expected.

An investigation was carried out by teams from various centres coordinated by the EPM (Ergonomics of Posture and Movement) Research Unit on 54 different hospitals in various regions of northern and central Italy. The teams examined a total of 3341 health workers whose job involved manual handling of patients (553 male and 2788 females, 1568 working in hospitals and 1773 in geriatric residences). Numerous meetings were held to ensure that the methods of assessing the exposure indexes and spinal impairment were identical in the various teams. The final data were processed centrally at the EPM Research Unit. The sample analyzed may be considered as representative of the situation in hospitals in Italy, at least for northern and central Italy. The mean age was 36 years, mean length of service in the department 6 years and mean length of job duration not exceeding 10 years; staff turnover was high. Physical examination revealed that 8.4% of the workers had had at least one episode of acute low back pain in the previous 12 months: i.e., 4 times the values of the reference groups. Also in the case of clinical-functional spondyloarthropathies of the lumbosacral spine, in the females there was a significantly higher prevalence than in the reference groups. All disorders were more severe in sectors more at risk, i.e., old peoples homes, rehabilitation centres, orthopaedic and surgical departments, and in any case higher in old peoples homes and geriatric residences. The initial data concerning the ratio between presence of spinal disease and risk index were also positive.